Cognitive Analytic Therapy (CAT) for individuals …

1 1 Cognitive Analytic Therapy (CAT) for individuals with personality disorder This section describes the knowledge and skills required to carry out Cognitive Analytic Therapy (CAT) with people who experience personality disorder. It is not a stand-alone description of technique and should be read as part of the competencies framework for individuals with personality disorder. Source: Ryle, A. and Kerr, I. B. (2002) Introducing Cognitive Analytic Therapy . Principles and Practice. Chichester: Wiley.

2 Knowledge of CAT theory An ability to draw on knowledge that CAT is an interpersonal (or relational) Therapy that focuses on repeating patterns in relationships An ability to draw on knowledge that CAT is an integrative Therapy that draws on different theoretical perspectives (particularly certain Cognitive and Analytic perspectives, Vygotskian activity theory and Bakhtinian concepts of the dialogically- constituted self)) An ability to draw on knowledge that individuals are assumed to develop a repertoire of characteristic reciprocal roles which reflect their early formative experience, particularly in relation to caregivers, and that: In optimal circumstances individuals will internalise a range of healthy and adaptive reciprocal roles which enable them accurately to appraise and predict the behaviour of others and to respond adaptively and prospectively to them and to the challenges of life.

3 individuals learn implicitly how to enact both poles of a reciprocal role and may enact either the parent-derived or the child-derived pole ( someone abused as a child may present as a victim of abuse, but then may recount ways in which they treat others abusively, or may verbally abuse the therapist) reciprocal roles can be enacted in relation to others ( treating others in an abusive manner) and/or towards the self ( treating the self abusively through self -neglect or self-harm) where one pole of the reciprocal role is too painful to experience individuals may consistently attempt to locate themselves at the opposite pole ( someone who has been bullied cannot bear to be the one who is bullied and humiliated.)

4 Consequently they consistently adopt the position of being the one who bullies others) An ability to draw on knowledge that CAT is particularly concerned with internalised reciprocal roles governing interpersonal relating and self-management, and assumes that these: are templates for relating that underpin the individual s expectations, characteristic feelings and behaviours in relationships, as well as the pressures they put on others to behave in predictable ways or to reciprocate are pairs of roles, each pole of which indicates how one person acts towards another, and the feelings associated with that relationship ( abusive to abused, associated with feelings of being angry and worthless)

5 Usually comprise a parent-derived pole (reflecting the behaviour of a caregiver or culture towards the individual) and a child-derived pole (reflecting the experience of the child) ( loving and affirming (parent-derived role) to loved and secure (child-derived role)) 2 An ability to draw on knowledge that the nature of an individual s reciprocal roles will reflect both: their internalisation of the actual behaviour of significant others towards them when they were a child the individual s genetic constitution, temperament and stage of development ( a depressed parent may be experienced as abandoning and unavailable by a very young child, whereas an older child might appreciate that the parent was preoccupied but concerned ).

6 An ability to draw on knowledge that although the focus is on the internalised experience (and on the empathic validation of this experience), CAT does not assume that this is always an accurate account of external reality An ability to draw on knowledge that CAT focuses on reciprocal role procedures (aim directed sequences of mental and behavioural processes, associated with affect, usually out of awareness and used as guidelines for action) : aiming to feel safe in a relationship leading to a self-defeating procedure of seeking constant reassurance from a partner An ability to draw on knowledge that reciprocal role procedures (RRPs) which become problematic are often developed as a means of coping with or responding to the unbearable feelings or unmet needs associated with the RRs.

7 An individual who has an underlying RR of critical to criticised and worthless , might develop a procedure of striving and perfectionism to win approval, but this might become a problem procedure if they become unable to tolerate mistakes or limitations in themselves An ability to draw on knowledge that CAT entails working in collaboration with the client to help them revise problem procedures ( the identification of exits ), for example by ,: adopting an alternative course of action ( responding to anxieties by taking small steps, rather than avoiding a feared situation) enacting more constructive RRPs in specific situations ( responding to abusive treatment by protesting or walking away, rather than escalating an argument) finding ways of addressing the unmet needs and unmanageable feelings associated with specific poles of the RRs ( using self-care strategies to address feelings of deprivation or neglect, rather than resorting to excessive self-control).

8 An ability to draw on knowledge that CAT identifies three main types of problematic procedure : Dilemmas : where the individual feels constrained to choose a course of action or mode of being which is artificially polarised between two alternatives ( either I m a bully or I m a martyr ) Traps : where the individual believes that action will lead to negative outcomes, and proceeds to act in ways which fulfil their negative expectations, hence confirming the original negative belief ( someone feeling pessimistic about their chances of forming relationships reacts by being hostile to others, who then respond negatively, hence confirming expectations of failure) Snags.

9 - where the individual abandons a legitimate aim or goal because of an expectation that its fulfilment will lead to negative consequences for the self or others ( it s not worth trying because if I do succeed others will envy and resent my success ) An ability to draw on knowledge that CAT involves helping the client develop awareness of their procedures, and so be able to predict and consider making changes to them 3 Knowledge of key features of CAT An ability to draw on knowledge that CAT is an integrative Therapy incorporating methods from.

10 Cognitive therapies ( self-monitoring, identifying unhelpful cognitions, use of tasks and homework, goal-setting) Analytic therapies ( attention to the therapeutic relationship and enactment of interpersonal problems within the relationship) theories of the social and dialogical formation of the self ( identifying and challenging internal voices, or creating a benign and collaborative therapeutic relationship which may itself be internalised) An ability to draw on knowledge that CAT is a time-limited Therapy which emphasises the importance of ending well by using the time-limit to address issues such as separation, , mourning, and dependence / independence.